[Management of zygomatic fractures via a transconjunctival approach with lateral canthotomy while preserving the lateral ligament]. / Versorgung von Jochbeinfrakturen über einen transkonjunktivalen Zugang mit lateraler Kanthotomie unter Schonung des lateralen Lidbandes.

INTRODUCTION: This study reports on a modified approach to treat zygomatic fracture. For the surgical approach, a transconjunctival incision and, instead of a lateral canthotomy, a superficial incision of the skin and subcutaneous tissue was used, preserving the lateral ligament. The results are compared with those of previous techniques, especially the subciliary incision. PATIENTS: In a prospective study, 30 patients (9 females and 21 males, mean age 32.1 years) with zygomatic fractures were operated using this approach. Mean follow-up time was 6 months after removal of the plates. Fractures were caused by trauma due to fighting, bicycle falls, or sport accidents. Follow-up radiographs were used to evaluate the position of the zygoma after reduction and rigid fixation. RESULTS: Reduction and rigid fixation of the fractures were possible to perform in all cases. The access to the orbital floor and the exposure of the inferior and lateral rim were satisfactory and an additional latero-orbital cut was not necessary. The disadvantage of the complete incision of the lateral ligament with the necessity of intraoperative refixation and possible ectropium of the eyelid could be avoided. Injuries or infections of the cornea or the bulbus did not occur. Postoperative complications such as scar formation resulting in entropium or ectropium were not seen. CONCLUSION: These results show that the transconjunctival approach with lateral superficial incision preserving the lateral ligament for treatment of zygomatic fractures is satisfactory in all cases of rigid fixation of both inferior and lateral rims. Because of its esthetic and functional advantages this approach has become standard in our department.

[Pain therapy in ophthalmology]. / Schmerztherapie in der Augenheilkunde.

The adequate therapy of a disease always includes the analgesia. Ocular pain can be classified with respect to its location and a therapeutic recommendation of therapy can be given accordingly. The following four locations can be distinguished: 1. Pain at the surface, 2. Deep pain. 3. Retro- and parabulbar pain and 4. Special cases. In the management of pain it must be considered, that the first therapeutic aim is the curative treatment; only the second is the treatment of pain. The use of analgetics has to be evaluated permanently and must be adapted to the needs of the patient in order to minimize side-effects. The most important goal is the improvement of the patient's quality of life.

[External ophthalmic myiasis cause by Oestrus ovis (sheep and goat botfly)]. / Ophthalmomyiasis externa durch Oestrus ovis (Schafs- und Ziegenbremse).

HISTORY AND CLINICAL DATA: The case of a 22-year-old woman is presented. The patient complained of a severe foreign-body sensation, immediately after being back at home from vacation in Greece. The eye showed redness and hyperaemia. The cornea was slightly clouded. On the tarsal plate white larvae of an approximate length of 1.5 mm and width of 0.5 mm were moving. The visual acuity was 1,0 and the inner parts of the eye were clinically inconspicuous. TREATMENT AND FOLLOW UP: The parasites were removed and preserved. After instillation of Betaisodona into the conjunctival sac antibiotics (Aureomycin) were prescribed. After 2 days the clinical signs had disappeared nearly completely. An ENT-examination showed regular findings. The larva was identified as a first-instar larva of Oestrus ovis. This insect causes external ophthalmomyiasis. The larva develops into an adult fly. O. ovis is well known as a parasite in the nasal cavities of domestic sheep and goats. CONCLUSION: The infestation of a human eye with maggots of a fly is a rare disease. The parasites are very mobile and clinical signs are variable. A penetration into the eye is possible. Since people have been travelling more often the infection with parasites has a greater probability, although these insects are living in central Europe and in Germany.